131,000 women a year with postpartum psychosis, of which it’s suspected they do not get top care if getting any care at all, with a higher prevalence and worse care in developing countries.
Launch of the Global Alliance for Maternal Mental Health – Dr Alain Gregoire, International Marce Society Conference 2016.

Severe Postpartum Mood Disorders – Who’s Really at High Risk? – Professor Ian Jones, International Marcè Society Conference 2016.

It is important to know more about the risk for postpartum psychosis as an opportunity for intervention and prevention to avoid devastating outcomes. Postpartum psychosis has a rapid onset with the vast majority of cases in the first 3 days to 1 week.

The risk for developing postpartum psychosis is not evenly spread across the perinatal spectrum. Certain groups of women are at a higher risk including  bipolar disorder and those who have previously experienced postpartum psychosis.

The risk for postpartum psychosis is about 50% if the mother has experienced a previous episode. The recurrence rate range is 14-57%, the differences in rates accounted by the differences in methodologies, differences in managements and the differences in the classification of bipolar disorder.

The risk profile for postpartum psychosis is different to bipolar disorder warranting different approaches for treatment. The lifetime pattern of postpartum psychosis has a strong association with bipolar I. A problem with diagnosis of postpartum psychosis occurs as 10% of the population is on the bipolar spectrum, along with with over-diagnosis, perceptions of psychiatrists, pressure from patients to give a label. All this matters because of the overburden of services, worry women unnecessary, combining bipolar disorder with postpartum psychosis underestimates the risk and can include the wrong women in research studies.

Women who have no perinatal episode have a 32% risk of postpartum psychosis. Further variables do not add to the predictive value of having an episode in a first pregnancy. There is a vulnerability of sleep loss in experiencing a manic episode.


There is research into the genetic markers of postpartum psychosis however this is dependent on sample size. Professor Ian Jones is seeking DNA samples from women who have experienced postpartum psychosis.

References

Di Florio et al. 2013. Perinatal episodes across the mood disorder spectrum.

Langan Martin et al. 2016. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study.

Kendell et al. 1987. Epidemiology of puerperal psychoses.

Robertson et al. 2005.  Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis.

Bergink et al. 2012. Prevention of postpartum psychosis and mania in women at high risk.

Katie Lewis et al. 2016. Is sleep disruption a trigger for postpartum psychosis?

Jones & Craddock 2007. Searching for the puerperal trigger: molecular genetic studies of bipolar affective puerperal psychosis.

Bergink et al 2013. Immune system dysregulation in first-onset postpartum psychosis.